'Magic' Overdose Drug Works, But Demand And Price On The Rise

Several states distribute Naloxone hydrochloride, also called Narcan, to treat opium-based drug overdoses. But only one company manufactures the drug, and the price has spiked in recent years.

Toby Talbot
/ AP

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Originally published on February 28, 2014 9:35 pm

Calls to the fire department for suspected drug overdoses are increasingly common in Revere, Mass. The department responded to 16 overdose calls in a single six-day stretch in February.

Revere is not alone. Across the country, communitiesare reporting a spike in opioid overdoses. And in several states, government agencies and health clinics are working to provide an anti-overdose drug, Naloxone, to as many people as possible. But even as use of the drug is rising, so is its cost.

Revere is one of five Massachusetts communities participating in a state pilot program where emergency responders administer the nasal spray form of the drug, also known as Narcan, to reverse the effects of an opioid overdose. There have been more than 2,500 reported overdose reversals in Massachusetts since the program began seven years ago.

"It's just incredible, it's like magic," says Michael Viviano, Revere's deputy fire chief. "There's somebody who's on the ground who's literally dead. They have no pulse. Sometimes they're blue, sometimes they're black. And you administer this stuff and sometimes, in a minute or two or three, they're actually up and talking to you."

But overdose deaths still continue. Exact numbers are not available, but Massachusetts State Police recently released figures showing that 185 people have died from heroin overdoses in the past four months.

That figure is probably much lower than the actual number of overdose deaths because it does not include prescription drug overdoses — or overdose numbers from three major cities, Boston, Springfield and Worcester, where heroin is a known problem.

"What really happened in the last year is there's a realization that these are not two separate epidemics, with prescription opioids and heroin users being different populations or different people," he says.

"What we're seeing now is the final common pathway for people who have opioid addiction is to use heroin."

In Boston, the city's newly elected mayor is trying to get Narcan to anyone who wants it. Mayor Marty Walsh has directed city health workers to offer Narcan training to police, fire officials and anyone who's interested.

Much of Boston's first Narcan community training session earlier this month was devoted to learning how to recognize an overdose. Boston Health Commission worker Berto Sanchez, who conducted the training, demonstrated how to put a small vial of liquid Narcan onto a nasal sprayer, a process that takes about two minutes.

Auta Almeida attended the training, she says, because a relative had overdosed. "I have extended family who actually has OD'd in the past year. And I want to know more information, also to educate my family," she says.

A Big Price Hike

While Narcan is handed out free of charge at these sessions, the cost of the drug has increased. Only one pharmaceutical company, Amphastar Pharmaceuticals, manufactures Narcan in the dosage that's used as a nasal spray. Seven years ago, Massachusetts paid $22 per Narcan kit. Today, that kit costs $42.

Rita Nieves of the Boston Public Health Commission attributes that increase to demand. "[The manufacturer] doubled the price because they know what they have in their hands — a life-saving tool that everybody wants to use now."

Amphastar says it is not able to discuss its pricing history for competitive reasons.

The cost is one negative cited by critics of Narcan, who also argue that it encourages drug use by eliminating overdose fears.

But emergency workers like Revere Fire Captain Jay Picariello say it's their job to do whatever it takes to save lives. "Someone loves that person that overdosed," he says. "It's valuable for that reason. We're bringing ... a son back to a mother."

Seventeen states now use Narcan, and many officials are urging the federal government to step in so the drug can be even more widely distributed at a reasonable cost.

From NPR News this is ALL THINGS CONSIDERED. I'm Melissa Block. Opiate overdoses have soared across the country. That's left government agencies and health clinics working to distribute a drug that can reverse overdoses. In Massachusetts, a nasal spray form of the antidote called Narcan is being handed out to first responders, drug treatment centers and addicts' families. The idea is to stem a spike in opiate-related deaths but the cost of the drug is also rising. From member station WBUR, Deborah Becker reports.

DEBORAH BECKER, BYLINE: Calls like this to the fire department in Revere, Massachusetts, are increasingly common. In just a six-day stretch this month, the department responded to 16 overdose calls. Revere is one of five Massachusetts communities participating in a state pilot program where emergency responders administer the drug Naloxone, or Narcan, to reverse the effects of an opioid overdose.

MICHAEL VIVIANO: It's just incredible. It's like magic.

BECKER: Michael Viviano is Revere's deputy fire chief.

VIVIANO: There's somebody who's on the ground who's literally dead. They have no pulse. Sometimes they're blue, sometimes they're black. And you administer this stuff and it's sometimes, within a minute or two or three, they're actually up and talking to you.

BECKER: Since Massachusetts began the pilot program seven years ago, there have been more than 2,500 reported overdose reversals. But overdose deaths continue. Exact numbers are not available but Massachusetts state police recently released figures showing that in the past four months, at least 185 people have died in the state from heroin overdoses. That's probably much lower than the actual number because it does not include either prescription drug overdoses or numbers from the state's three largest cities where heroin is a known problem.

ALEX WALLEY: What's really happened in the last year is there's a realization that these are not two separate epidemics, with prescription opioids and heroin users being different populations or different people. What we're seeing now is that the final common pathway for people who have opioid addiction is to use heroin.

BECKER: In Boston, the city's newly elected mayor is trying to get Narcan to anyone who wants it. Mayor Marty Walsh has directed city health workers to offer Narcan training to police and fire officials and anyone interested. Earlier this month at the first community Narcan training session, Boston Health Commission worker Roberto Sanchez conducted a 45-minute training. Most of it involved how to recognize an overdose. It took about two minutes to demonstrate how to put a small vial of liquid Narcan onto a nasal sprayer.

(SOUNDBITE OF TRAINING SESSION)

ROBERTO SANCHEZ: The two yellow pieces on each end, they come right off. Just take that out, grab the itemizer and put that on the other end. You're ready to administer now.

BECKER: Auta Almeida listened intently. She was there to get Narcan because a relative OD'd.

AUTA ALMEIDA: I have extended family who actually has OD'd in the past year. And I want to know more information, also to educate my family.

BECKER: At these sessions, Narcan is handed out free of charge, but the cost of the drug has increased. Seven years ago, Massachusetts paid $22 for a Narcan kit. Today that kit costs $42. The Boston Public Health Commission's Rita Nieves attributes that to demand.

RITA NIEVES: They doubled the price because they know what they have in their hands, a life-saving tool that everybody wants to use now.

BECKER: Only one pharmaceutical company manufactures Narcan in the dosage that's used as a nasal spray. The company, Amphastar Pharmaceuticals, says it's not able to discuss its pricing history for competitive reasons. The cost is one negative cited by Narcan critics. They also argue that Narcan encourages drug use by eliminating overdoes fears. But emergency workers like Revere Fire Captain Jay Picariello say it's their job to do whatever it takes to save lives.

JAY PICARIELLO: Someone loves that person that overdosed. And, you know, it's valuable for that reason. You know, we're bringing back - a son back to a mother.

BECKER: Seventeen states now use Narcan and many officials are urging the federal government to step in so the drug can be even more widely distributed at a reasonable cost. For NPR News, I'm Deborah Becker in Boston. Transcript provided by NPR, Copyright NPR.